Existing hospitals and other large medical facilities typically include a central pharmacy staffed by trained pharmacists and other personnel who fill, by hand, patient-specific prescriptions ordered by individual doctors for their patients being treated at the facility. The pharmaceuticals dispensed by the pharmacy include a wide range of medications, including prescription and non-prescription (over-the-counter or OTC) medications in individual unit-of-use (single use) packages. A typical hospital pharmacy must stock 1500-2000 separate drugs or other line items, of which, on a typical given day, a total of 300-350 different items might be actually used. Certain medical supplies, such as syringes, inhalers, bandages, IV (intravenous) tubes are typically included in such a system.
This institutional-type pharmaceutical-dispensing system, known generally as a "Unit Dose Drug Distribution System", is quite labor-intensive, with each filled medication order comprising individually packaged pills, syringes, patches, etc. in unit-of-use packages. The correct items are hand-picked and placed into each patient's bin (which is hand-labeled with the patient's name), before it is transported in multi-bin groups known as cassettes to and from patient care areas (wards) on transport carts for bed-to-bed dose administration to individual patients by a nurse. The mode and timing of transporting the medications and supplies can vary widely, from being hand-carried to and from patient wards on large cassette transport carts, usually once every so many days (anywhere from daily to seven days) for patient-specific bins, or after-hours doses or starter doses by some other delivery system, such as pneumatic tubes (many times per day) which deliver medications to and from wards without a human carrier, or by semi-automatic vending machines which are refilled by hand one to three times daily.
Typically, when the medication cassettes arrive at the ward, such as on a transfer cart, they are exchanged into and out of mobile carts or stationary cabinets, referred to as medication carts, for later use by the nurses. In such a system, each patient has two bins, one in actual use at the nurse's station (ward) and one being refilled in the pharmacy. In other systems, a single patient bin is labeled and replenished on the ward using a mobile pharmacy cabinet. In nearly every hospital, the patient bins are replenished every one to seven days, with hand-picked/placed patient-specific medication doses.
The carts with the patient bins are usually stored in a medication room at the nursing station in each ward. Typically, the medications are administered by a nurse four times per day. The nurses use a patient profile book to ensure accuracy of medication and administration. The patient profile book is identical to the book used by the pharmacists to fill the patient bins.
The medication carts vary widely in size, arrangement and sophistication, from a very simple cabinet having several shelves for storage of medications for several patients to cabinets having individual bins which are identified according to patient. Typically, medication cabinets are locked and can only be accessed by authorized personnel. In some cases, each individual patient bin or receptacle in the cabinet is individually locked as well.
Such a pharmaceutical system, as indicated above, is heavily labor intensive, particularly for the trained pharmacists, who hand pick and then place the medications in the patient bins, and has a high potential for errors, during the filling of the medication order, during delivery of the medication doses to the ward, and finally during administration of the doses to the patient. The conventional systems are quite slow, taking several hours in some cases to complete a run of medications for an entire hospital, for instance. In addition, the medications already in a patient's bin may be superseded at any time by new orders from the doctor, which can result in confusion as to proper medications for the patient and/or delays in the administration of desired medications.
While it is generally desirable to have patient medications delivered faster in an institutional setting, such as a hospital, i.e. more often than once per day, existing systems are so laborious that such timely deliveries of medications are virtually impossible. It is also well accepted that it would be most desirable to have correct, up-to-date medications delivered just in time (JIT) before they are to be administered to the patient, typically at 8 AM, 12 Noon, 4 PM and 8 PM (hospital times). Other medications for a patient may be provided on an as-needed basis. In addition, it is desirable to have any change in patient medications ordered by a doctor effective immediately, in time for the next medication time. Again, due to cost and the cumbersomeness of existing systems, such a goal has to date been difficult, if not impossible, to obtain.
There have been a few attempts at automating medication dispensing systems in hospitals, but these have not improved overall delivery time significantly, and further are not integrated into an overall system; hence, errors and inefficiencies in the overall system of medication delivery still occur. Centralized pharmacies, where doctors' prescription orders are hand-filled by trained pharmacists, are still the overwhelmingly (95%) used system for hospitals and other large medical facilities.
As indicated above, however, a truly automated and complete medication management and dispensing system is highly desirable for hospitals and other large institutional medical facilities. In such a system, a patient's medication orders will be filled automatically and quickly, and be delivered to the patient ward just before each dosage time. Such a system would also desirably permit the more efficient and more valuable use of pharmacists in a primary role as drug therapy advisers as opposed to filling prescription orders.
Such a system would also correct or significantly improve existing difficulties and inefficiencies in inventory management, permitting appropriate stocking of medications and supplies which move quickly, while not overstocking medications and supplies for which there is little demand. Still further, there is a recognized need and desire in the medical community for an integrated medication management system in which the filling of medication orders and the delivery of those medications to the patient includes multiple safety checks to ensure that the patient receives exactly those medications ordered by the patient's doctor, in the correct dosage, at the right time, and that the medications are those set out in the most recent, up-to-date order of the doctor.